Summary Report for FSPSAs Ending During the Report Period Center: 53
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs ending between: 10-01-23 and 12-31-23 Date of Report: 01-14-24 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1116 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 22 22 38.750000 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 22 22 38.750000 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 8 8 7.194444 $348.9300 $48.5000
AUDE -92550 TYMPANOMETRY & REFLEX THRESH 1 1 1.000000 $15.8400 $15.8400
AUDE -92557 COMP AUDIO THRESHOLD EVAL/SPCH RECO 51 51 29.055556 $641.2600 $22.0700
SPCH -92521TL EVAL OF SPEECH FLUENCY 1 1 1.000000 $51.4100 $51.4100
SPL -92526TL TREATMENT OF SWALLOWING DYSFUNCTION 2 2 13.714285 $705.0500 $51.4100
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Subtotal (Total Children Is Unduplicated) 62 63 51.964285 $1762.4900 $33.9200
EI Services, Class # 03
ASST -ASST ASSISTIVE TECHNOLOGY 9 12 10.438888 $52194.0000 $4999.9600
AUDE -V5160 DISPENSING FEE BINAURAL 4 4 4.000000 $926.4800 $231.6200
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 12 15 17.400000 $870.0000 $50.0000
COIFF -COIFFGT IFSP CONSULT, PROF, TELEMEDICINE 2 2 1.250000 $62.5000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 1 1 1.000000 $25.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 8 9 16.195238 $809.7700 $50.0000
CONIF -CONIFGT CONSULT, ITDS, TELEMEDICINE 1 1 1.000000 $50.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 54 57 96.615874 $4830.8000 $50.0000
CONOF -CONOFGT CONSULT, OT, TELEMEDICINE 4 4 3.461111 $173.0600 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.166667 $4.1700 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 29 29 46.077777 $2303.8900 $50.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 34 35 36.723013 $1836.1400 $50.0000
CONSF -CONSFGT CONSULT, SLP, TELEMEDICINE 3 3 5.200000 $260.0000 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 4 4 4.571429 $114.2900 $25.0000
EIIF -96154 HEALTH AND BEHAVIOR INTERVENTION 4 5 25.809525 $1290.4700 $50.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 243 249 1077.449208 $53872.4300 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 16 18 54.723812 $2736.2000 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 304 380 1563.165883 $18757.9700 $12.0000
OCCT -97530 OT SESSION BY LICENSED OT 46 48 301.333336 $21683.9400 $71.9600
OCCT -97530TL OT SESSION BY LICENSED OT 24 24 97.276191 $7000.0200 $71.9600
OCCT -97530TLGT OT SESSION BY LICENSED OT 1 1 1.533333 $110.3400 $71.9600
PHY -97110 PT SESSION BY LICENSED PT 17 17 108.828573 $7831.3000 $71.9600
PHY -97110GT PT SESSION BY LICENSED PT 4 4 33.995239 $2446.3000 $71.9600
PHY -97110TL PT SESSION BY LICENSED PT 21 21 108.796826 $7829.0300 $71.9600
PHY -97110TLGT PT SESSION BY LICENSED PT 2 2 11.000000 $791.5600 $71.9600
SENS -V5060 BEHIND EAR HEARING AID 1 1 1.000000 $229.6100 $229.6100
SENS -V5264 EARMOLD 1 1 1.000000 $18.1300 $18.1300
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 45 49 218.828571 $15746.9100 $71.9600
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 2 1.500000 $107.9400 $71.9600
SPL -92507TL SPL THERAPY SESSION BY LICENSED SLP 29 32 115.215875 $8290.9400 $71.9600
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Subtotal (Total Children Is Unduplicated) 456 1031 3965.556369 $213203.1700 $53.7600
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Total 1116 4056.270654 $214965.6600 $53.0000
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Number of Children (Unduplicated) With at Least One Authorization 482